Getting Ready The Approach to the Interview

Interviewing patients to obtain a health history requires planning. You are undoubtedly eager to begin your relationship with the patient, but you should first consider several points that are crucial to success.

Taking Time for Self-Reflection. As clinicians, we encounter a wide variety of people, each one of whom is unique. Establishing relationships with individuals from a broad spectrum of ages, social classes, races, ethnicities, and states of health or illness is an uncommon opportunity and privilege. Being consistently open and respectful toward individual differences is one of the clinician's challenges. Because we bring our own values, assumptions, and biases to every encounter, we must look inward to clarify how our own expectations and reactions may affect what we hear and how we behave. Self-reflection is a continual part of professional development in clinical work. It brings a deepening personal awareness to our work with patients and is one of the most rewarding aspects of providing patient care.

Reviewing the Chart. Before seeing the patient, review his or her medical record, or chart. The purpose of reviewing the chart is partly to gather information and partly to develop ideas about what to explore with the patient. Look closely at the identifying data (age, gender, address, health insurance), the problem list, the medication list, and other details, such as the documentation of allergies. The chart often provides valuable information about past diagnoses and treatments; however, you should not let the chart prevent you from developing new approaches or ideas. Remember that information in the chart comes from different observers, and that standardized forms reflect different institutional norms. Moreover, the chart often fails to capture the essence of the person you are about to meet. Data may be incomplete or even disagree with what you learn from the patient—understanding such discrepancies may prove helpful to the patient's care.

Setting Goals for the Interview. Before you begin talking with a patient, it is important to clarify your goals for the interview. As a student, your goal may be to obtain a complete health history so that you can submit a write-up to your teacher. As a clinician, your goals can range from completing forms needed by the health care facility or insurance companies to testing hypotheses generated by your review of the chart. A clinician must balance these provider-centered goals with patient-centered goals. There can be ten-ion between the needs of the provider, the institution, and the patient and imily. Part of the clinician's task is to consider these multiple agendas. By aking a few minutes to think through your goals ahead of time, you will find it easier to strike a healthy balance among the various purposes of the interview to come.

Reviewing Clinician Behavior and Appearance. Just as you observe the patient throughout the interview, the patient will be watching you. Consciously or not, you send messages through both your words and your behavior. Be sensitive to those messages and manage them as well as you can. Posture, gestures, eye contact, and tone of voice can all express interest, attention, acceptance, and understanding. The skilled interviewer seems calm and unhurried, even when time is limited. Reactions that betray disapproval, embarrassment, impatience, or boredom block communication, as do behaviors that condescend, stereotype, criticize, or belittle the patient. Although these types of negative feelings are unavoidable at times, you must take pains not to express them. Guard against them not only when talking to patients but also when discussing patients with your colleagues.

Your personal appearance can also affect your clinical relationships. Patients find cleanliness, neatness, conservative dress, and a name tag reassuring. Try to consider the patient's perspective. Remember that you want the patient to trust you.

Improving the Environment. Try to make the setting as private and comfortable as possible. Although you may have to talk with the patient under difficult circumstances, such as a two-bed room or the corridor of a busy emergency department, a proper environment improves communication. If there are privacy curtains, ask permission to pull them shut. Suggest moving to an empty room rather than having a conversation in a waiting area. As the clinician, part of your job is to make adjustments to the location and seating that make the patient and you more comfortable. Doing so is always worth the time.

Taking Notes. As a novice you will need to write down much of what you learn during the interview. Even though experienced clinicians seem to remember a great deal of the interview without taking notes, no one can remember all the details of a comprehensive history. Jot down short phrases, specific dates, or words rather than trying to put them into a final format. Do not, however, let note-taking or using written forms distract you from the patient. Maintain good eye contact, and whenever the patient is talking about sensitive or disturbing material, put down your pen. Most patients are accustomed to note-taking, but for those who find it uncomfortable, explore their concerns and explain your need to create an accurate record.

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